by Josan
Walter knew he was pretending because he hadn't reacted
to the very obvious foul the referee had missed against
his favourite team. He sat back in his corner, feet up
on the coffee table and watched Alex, eyes downcast,
playing with a hole in one of the knees of his old
sweatpants.
Something was bothering his lover again. Walter shook
his head slightly. Damn! Getting Alex to spill what
was on his mind took more patience than... than dealing
with the X-Files! He would, eventually, tell him what
was on his mind, but often he needed a little prod to
get going.
Whatever it was, this time, it had been stewing in him
for the past few weeks. And from the lack of
attention, the day-dreaming, the occasional deep sighs,
Walter had a feeling this one was not going to be
something easily handled with just a few comforting
words and a bout of hot sex.
Come to think of it, it had been a while since they'd
had a bout of hot sex. More than a couple of weeks.
Closer to three, no, four. They made love just as
frequently, but more vanilla flavoured than the hot,
spicy sessions Alex liked to initiate. Walter always
made a few token protests at the start of these, more
out of ritual than real meaning. Alex enjoyed
considering it as a challenge, getting him to ignore
his age and behave like a randy rabbit rather than a
fifty-two year old man whom the statistics claimed
should not be able to get it up several times in a
night. He never protested very strongly: he hoped
Alex hadn't taken the last set to heart.
"What?" Alex had looked up and caught him staring.
Walter decided to take the bull by the horns. "What's
wrong, Alex? And don't tell me nothing's wrong.
You've been far too introspective even for a crazy
Russian like you."
Alex gave a ghost of a smile at that. Walter reached
out a hand and waited. He saw the decision in his eyes
before Alex moved to lie, head on Walter's lap.
So, thought Walter, his crazy Russian needed a little
pampering. Alex only lay like this in his lap when he
felt the need for comfort. Walter said nothing, just
played with Alex's hair, massaged his back along his
spine, stroking him like a cat. Kneaded the sore
muscles of the truncated arm.
Alex made a soft sound, not of pleasure, but of pain.
Walter immediately stilled his hand. So that was it:
the arm was hurting again. Now that he thought of it,
that would explain why the prosthesis came off as soon
as Alex arrived home, why he didn't wear it at all on
weekends. He moved his hand to Alex's neck and left it
there, offering silent encouragement.
Alex sighed.
He snuggled more into Walter's warmth. After a few
minutes he said, "I went to see Fischer about my arm.
He wants to send me to a specialist. For an
operation."
"I see." And Walter did. "What do you think?"
"Part of me knows he's right."
"And the other part of you?"
Alex didn't answer. He moved even closer to Walter.
Walter placed both his hands on Alex, silently offering
support. One hand smoothed back the hair off his face
so he could see whatever expression Alex allowed to
show. The other continued rubbing in small circular
motions along the tensed back.
"You remember that segment on 60 Minutes?"
"Which one?"
Alex took a deep breath. "The one on how some people
were just paralysed under anaesthetic, not knocked out?
How they felt the knives?"
Oh, shit! Yes, he remembered that one. Alex had
turned white and gone to get a beer. He'd returned
only after the segment was over.
"I know it's stupid," began Alex.
"Hush! Not stupid, Alex. A very valid concern."
Christ, a more than valid concern in this case. Walter
kept his voice conversational. "Have you discussed
this with Fischer?"
Alex shook his head.
"Alex. Joe's aware of what happened to you. He will
take this seriously if you talk to him about it. He
won't scoff off your fears. You know that."
"Yeah, I know that. But somehow that doesn't help."
Joe Fischer had no trouble taking Alex's concerns
seriously: he too had seen the 60 Minutes segment on
"awareness".
Walter had gone with Alex to discuss the problem. He
listened while Joe explained about a special BIS
Monitor that could be used. The monitor tracked brain
electrical activity: the higher on the scale the BIS
displayed, the more likely the patient would be aware
and awake.
Could he guarantee it would be 100% effective? Joe
looked from Alex to Walter then back to Alex. No, he
couldn't. He personally had no experience with it. He
had heard that Rush Surgicenter in Chicago had
supposedly had a fair amount of success with the
monitor, but nothing was 100%. And he would have to
find out if the surgical team he wanted to recommend
used it.
Would he be alone in the operating room? Well, normal
procedures could be put aside in special considerations
...Joe would see to it that this one would fall under
that category, so he could accompany... No, not him.
Walter. Could Walter accompany him in?
Walter let nothing show on his face, but the thought of
standing by, watching his lover's arm being further
amputated... having to worry if he were really under or
once more feeling the knives...
They both had things to think about after they left
Joe's office.
After leaving a Walter who felt the situation was
clearer for having heard himself talk about it out
loud, Louisa surprised Alex at his office. Insisted on
going out for coffee. She couldn't use any of her
usual methods on him: he wasn't her brother, he wasn't
a musician she was tending through to the next level.
But she had eyes and used them to register the shadows
under his, the fact that his attention wandered a few
times while she was telling him about the group she had
come here to D.C. to hear, that he seemed more listless
than his usual quiet.
She returned that afternoon to New York, thought about
the situation during the flight, during the taxi ride
home. On the fridge, Eli had left her a note about how
he would be probably pulling an all-nighter at the
studio. She made herself a sandwich, plopped herself
on the couch and settled in for a long call to her
mother.
Nadia asked her eldest grandson to find her the
information she needed using her computer. She was
adequate on it, but Gene Jr. was a whiz. It took him
an afternoon to pool together all the information she
needed. That evening, she sat in her favourite chair
and reviewed all material he had found for her. She
really wasn't too surprised to find that the son of one
of her colleagues on the Church Board popped up often
in the documentation on orthopaedic surgery. The man
whose specialty was dealing with rebuilding the limbs
of deformed children, of children affected by land-
mines had quite a reputation. As she well knew since
Cynthia often bragged about the work her son did.
Nadia thought that a man used to dealing with terrified
children would be able to handle their Alex with the
gentleness he needed.
The next morning she called Cynthia and invited her
over for coffee and cake, ostensibly to discuss the
campaign for raising funds to repair the church roof.
Cynthia never realized what Nadia really wanted was the
present itinerary of her surgeon son.
Of course, neither Walter nor Alex was aware of the
family discussions and plans that were going on behind
their backs.
Walter might not have been surprised if he had learnt
of it: he was used to his mother and her involvement
in her children's lives. Especially when Nadia thought
she knew what was best for them. She had certainly
presented Jilly and Gene with finalized plans to
expedite them on their way when Jilly began having
second thoughts, yet again, about Africa. And she had
been right: Gene and Jilly had both found outlets for
their energy. Gene was teaching American History in an
integrated university: Jilly was involved, new baby
and all—yet another boy—in a literacy program for
women. Amy had returned from spending Christmas with
them with the news that they would be spending another
year in Africa.
Alex was completely taken aback when Nadia called one
afternoon, about two weeks after Louisa's visit to
inform him that he had an appointment with Doctor Leo
Courville that coming Monday at the University Hospital
in Burlington. That he should bring his latest x-rays
with him, the results of his last check-up.
When Alex stuttered he couldn't possibly get there for
Monday, Nadia informed him that the plane reservations
were already made and to be certain he and Walter left
early enough to avoid possible traffic jams on the
Beltway.
"Alex? What's wrong?" Walter wondered what the hell
his mother had said to Alex to make him turn white the
way he had.
Almost unable to speak, Alex handed Walter the phone
and sat down, not knowing how to handle the fact that
the decision as to the next step had been taken out of
his hands. He was barely aware of Walter's protests on
his behalf, his winding down under his mother's patient
explanation that they couldn't wait too long since Leo
was proposing to leave for Central America for six
months of volunteering his surgical skills at small
rural hospitals.
"Walter," she played her winning card, "he's used to
trauma victims. He works with children who have been
maimed by war. Alexei will need that kind of
experience to get through this ordeal. And let's not
fool ourselves, Walter, it will be an ordeal for him.
Leo will make it easier for him. I promise, son."
Nadia was waiting for them when their plane landed.
She accepted Walter's hello kiss, and then stood
waiting to see what Alex would do. Walter stepped
back: this was between the two of them. He watched as
Alex, who had spent last night staring at the ceiling
of their bedroom, stop about a metre away from his
mother.
"Alexei."
"Nadezdah." Then asked the question that had been
plaguing him since the night of her phone call: "Why?"
"Because I love you, dear." She stepped up to him and
placed her hand on his cheek. "And I can't stand the
idea that you may be in pain." With a smile to comfort
the lost child she saw in his eyes, she kissed him on
the cheek.
And as if he were a child, she took his hand, held it
tightly as they walked out to the car. Walter drove
them to the hospital, watched as his lover held onto
his mother's hand for dear life all the time that they
waited for his name to be called.
For a moment there he felt a twinge of jealousy, that
Alex should lean on his mother at this time rather than
himself, but then he realized that what Alex needed at
this particular time was not a lover, but a parent who
would reassure him that all would be right. Still, he
couldn't prevent the little thrill when Alex's name was
called, it was he Alex looked to, to accompany him into
the doctor's examining room. Nadia smiled at both of
them, took a book out of her bag. The title registered
on Walter only after the door had closed: "Amputations
& Prosthetics".
Leo Courville was a teddy bear of a man, had the sort
of face that would immediately put a child at ease. It
took longer with Alex. They had both checked out
Courville's credentials, found them to be impeccable.
He had a superb reputation as a surgeon. Now Walter
watched as the man himself earned a reputation in his
eyes for his handling of Alex.
He was incredibly gentle, carefully explaining
everything he was doing before he went ahead and did
it. Explained why he was doing certain things,
explained what he was looking for in the x-rays that
Joe had taken just the day before as a special favour,
to put Walter's mind at rest that the x-rays they
brought with them would be the most recent.
There followed an intense discussion between doctor and
patient as to the type of prosthesis Alex wanted to
graduate to after the operation. It would be fitted
onto him as soon as possible after the operation
itself.
And then, almost with a nonchalance that belied the
anxiety it was causing him, Alex brought up the subject
of anaesthetic. Courville, used to parents
accompanying their child into his operating room,
immediately suggested Walter should do likewise. It
hadn't taken him more than a moment to understand the
relationship between the two men. And not more than
one glance at the butchery that had passed for
amputation to know that there had been a great deal of
pain associated with it. The note about Alex's fears
that Fischer had included in the medical file was a
logical fallout.
Courville explained that in the Third World countries
he often operated in, they didn't have the very latest
drugs, anaesthetics. He could see no problems in this
particular case about not using them. He proposed to
begin with a local anaesthetic, making sure the arm was
completely senseless before going to a general
anaesthetic, which would knock him out for the
operation itself. They would not use a neuromuscular
blocker, though they would have to use restraints.
Just in case. They would wait until he was asleep to
use them. Was that agreeable?
Alex actually looked relieved. Walter sighed. Damn!
His mother had been right again.
Nadia knew better than to gloat. Alex came out of the
examining room, looking like he had gotten rid of a
heavy weight. He kissed her cheek, whispered, "Thank
you."
Courville set the operation for a date two weeks away.
Time for both of them to arrange time off. Nadia
merely raised an eyebrow at them—looking very much
like a certain ex-AD, thought Alex—and informed them
that they would both be moving into her house for the
duration. Alex would need to be near enough to
Burlington to have his follow-up examinations.
Besides, it was spring and Walter could go fishing.
There were some nice trout streams in Vermont as he
already knew. And then there were a few little jobs
that needed doing around the house. Walter made a show
of groaning, protesting that the "few little jobs" were
probably several pages in length.
It had taken Walter a long time to fall asleep, but now
that he had, his soft snores covered the small sounds
of Alex slipping out of the bed. He pulled his
sweatpants on in the hallway and quietly made his way
down the stairs to Nadezdah's kitchen. With careful
movements, he made himself a mug of tea and sat, in the
dark, at the table to drink it. Early that morning,
he would check into the hospital in Burlington, be
prepared for evening surgery.
He knew it was the right thing to do: the arm hurt
more and more these days. he couldn't bear the
prosthesis any more, gasped at the pain whenever anyone
accidentally touched it. The operation was necessary.
He was all right with it. Well, he thought he had
been. Now, he wasn't so sure.
The creaking stair warned him he would no longer be
alone. But it was Nadia, not Walter, who joined him at
the table.
In the two weeks since his quick in-and-out visit to
the doctor, Nadia had been taken aback by the lines put
on his face by the pain Alex could no longer hide. And
by the fear that hovered just behind those eyes that
she could now read so much more easily than that first
visit.
She had been horrified when Louisa had told her how
Alex had lost the arm in the first place. One of the
things Walter had let drop in his conversation with
her. When Louisa had mentioned the 60 Minutes segment,
Nadia had immediately understood Alex's fears.
"Alexei. It will be all right. Leo has promised you a
sure way of seeing that there is no pain."
Alex nodded. "I know."
Nadia smiled. "Yes, dear. I know you know with this."
She touched his head. "But do you know with this?"
She touched his chest where his heart lay. "And with
this?" She dropped her hand to his stomach.
Alex gave a soft chuckle. "The heart is thinking it
over, but the stomach is definitely not certain."
Nadia's smile widened for a moment and then she grew
serious. "And do you hate me for pushing you into the
corner on this?"
Alex looked at her. "No. Walter explained you thought
you were doing it for my own good."
"I was. I am."
"He also explained that much to your children's disgust
you're usually right when you push an issue."
Nadia smiled again. "True. I am."
"But for your children."
"Alexei," Nadia cocked her head, "you are the one
Walter has chosen as his partner. That makes you my
child as well. And what mother cares to see one of her
children in pain?" She stood up and put her arms
around him. "It will be all right. I promise you."
Alex hid his face in her shoulder. "I'm afraid," he
whispered, voice rough with suppressed memories of the
forest in Tunguska, the follow-up operation in the
village by a doctor who had a scant amount of morphine.
"Yes, dear, I know. But you won't be alone. Walter
will be in there with you. And I'll be outside
waiting. Then Amy, Ouisa and Eli will be arriving from
New York the next day and we'll all be there for you."
She tightened her arms around him and gently rocked
him, comforting him.
Walter sat on the bottom of the steps and listened to
his lover cry out his fears in the security of his
mother's arms.
Nadia looked up from her book to watch her son—whose
complexion almost matched the green scrub suit he wore—come sit down besides her.
"How is he?"
Walter swallowed. "In recovery."
"I take it all went well?"
This time all Walter accomplished was a slight nod.
Nadia went and got a ginger ale from the vending
machine. She handed it to him, and then pulled a
plastic waste basket closer, just in case it was
needed.
"Your father never so much as flinched when he had to
deal with a car accident. He was cool, calm in the
face of any emergency that he had to handle in his job
as sheriff. The first time I saw him wearing the look
you have on now is when you fell out of the tree in the
back yard. You were four years old and you had somehow
managed to climb up about twelve feet. He saw you,
went to get you but you slipped and hit the ground
before he could get to you. Do you remember?"
Walter shook his head, managed a swallow of the drink:
it managed to stay down.
"You weren't badly hurt. Had most of the breath
knocked out of you, had a slight concussion. Your
father held you all the way to the hospital. I had
to drive. When we got there, the doctor thought he was
the patient he looked so sick.
"You spent one day in bed and were back to normal. It
took your father considerably longer. It's different
when it's someone you love."
Walter nodded. Nadia stood and put her arms around him
as she had Alex the night before. "You could have left
once he was asleep."
Walter shook his head against her shoulder. "I
promised him."
"Yes, dear. And even asleep, he needed you there."
She hugged him tightly.
Courville outfitted Alex with a self-controlled demerol
kit, though he closely monitored Alex's usage of it.
He was please with the way the operation had gone.
He'd had to remove about two more inches of the stump,
but the nerves would be less inflamed, would hurt less.
The phantom pain, a problem with any amputation, should
also occur less often. He was rather proud of the fact
that though not pretty, the new end of the stump would
be a lot less difficult to look at.
He smiled at Alex as he finished examining him. "I
must say the scariest moment was when I thought we were
going to lose your partner." He grinned at Walter who
was watching Alex's face. "Went a very interesting
shade of green there for a while."
Alex reached out for Walter with his hand. "Sorry."
He was less groggy today than yesterday.
"Brat," answered Walter.
"We'll release you day after tomorrow," continued
Courville, pretending he didn't see Walter stroking
Alex's hand with his free one. "There'll be a
prescription for painkillers with the others. I would
prefer that you use them as needed only, not more than
two every four hours. Then it's back in a week, for a
check up and for fitting your new toy. We'll start you
on your physio and Dr. Fischer said he would oversee
your program once you got back to Washington."
He'd been gone about a minute when the door opened and
Amy stuck her head in. "Uncle Alex, are you awake?
It's okay, Gram, they're only kissing." And pushed the
door to the sound of laughter.
Alex had been hurt before in his days with the
Consortium. When that happened, he usually went
underground, found himself a place to hide and stayed
there till he was better. He preferred to depend only
on himself, or, if he had to, maybe one other source to
provide him with medical help, food until he could take
care of himself, of his own needs.
But not this time.
He had thought he would move into the bedroom, ensconce
himself in bed and maybe see Walter with lunch and
supper.
Instead, once Walter had helped him with his morning
rituals, he found himself installed in the tv room, on
the couch that proved very comfortable. Nadia tucked a
blanket around him, fluffed up the pillows that
supported his back and head. Amy brought him a glass
of juice, Ouisa breakfast on a tray. Not just
breakfast for himself, but for all of them. Nadia had
made him a soft boiled egg and toast soldiers for
dipping into the yoke.
There was a fairly noisy discussion of what people
would be doing that day: Walter roped Ouisa into
helping him clean up the garden. Ouisa tried hard to
convince Eli that he should join them, but Eli refused,
saying he had more important things to do. Amy gobbled
her food, hurriedly kissed everyone good-day and rushed
off to school.
By the time he was left alone, Alex had the beginnings
of a headache, and a shoulder that throbbed. Nadia
didn't even ask him, she went and got his pills, held
out two to him and made sure he downed them with the
last of his juice. Then she helped him lie down,
kissed his forehead and left him alone. When she
checked in on him twenty minutes later, he was fast
asleep. She stopped Walter three times from going in
and checking on him before lunch.
By evening Walter appreciated the fact that his family
was treating Alex like they had anyone in the family
who had gotten hurt. Alex was simply overwhelmed. He
broached the subject that night in their bed, his head
on Walter's shoulder, waiting for his bedtime dose of
medication to take effect.
"Your mother keeps kissing me on the forehead."
Walter made some kind of agreeing noise. "She's always
checked for fever that way."
"And Ouisa gave me a head massage."
"Didn't it help with your headache?"
"Yeah." There was a slight pause. "Amy's forever
bringing me juice."
"Hmm. Courville explained that some of the medication
had a dehydrating effect. He told you to drink plenty
of liquids."
"Right. So then I've got to piss and Eli follows me to
the door of the john and back, like it was my leg that
was operated on, not my arm."
"Well, love, it has been only five days. And you are a
bit wobbly on your feet."
Alex scoffed. "I suppose I should be happy Jilly is in
Africa. She probably would follow me into the john,
lecturing me about the proper way to piss."
"No,' disagreed Walter, "she probably would hold your
dick and make sure the last drop gets properly shaken
off."
Alex laughed sleepily. "Still doesn't explain why
they're all doing this."
Walter rubbed his cheek against the silky hair that he
had washed himself that night before going to bed.
"You still don't get it, do you?"
Alex opened his eyes and looked at his lover, a bit
confused.
"You're family, Alex. That's how we take care of our
own in this family. We overwhelm them with attention.
Face it: you're just going to have to accept it all."
Alex nestled his head a little more comfortably on
Walter's shoulder. He thought a moment about the rat
holes he had hidden out in to recover from beatings,
gun shot wounds. Alone. Then he thought about the day
he had just gotten through, with people who were
concerned about him. Who cared for him.
"Okay," he said.
The BIS Monitor does exist, is being used at Rush
Surgicenter in Chicago. It is still not widely used.
"Awareness" was a segment on 60 Minutes. According to
AWARE (Awareness With Anesthesia Research Education),
of 20M Americans who have surgery every year, anywhere
from 40K to 150K experience some level of awareness.
I couldn't remember the name of the hospital in
Burlington, Vermont, so I made one up. Hey! It's only
a story.
Clean Cut
lex was sitting cross-legged at one end of the long
couch, pretending to be watching the soccer game.
Louisa dropped in unexpectedly that week for an over-
night visit and found both her brother and his lover
unnaturally quiet. Even for them. She kidnapped
Walter from his office for lunch and used a fair amount
of the loving blackmail sisters gather over the years
to get the situation out of him. And then did
something Ouisa did only for her nearest and dearest:
she let Walter talk it out of his system without once
interrupting, making only the most encouraging of
noises when he needed them.
The complete title of the book Nadia is reading is:
Amputations & Prosthetics: A Case Study Approach by
Bella J. May.
